FOR OFFICE USE ONLY
Street Address or RFD
County where business located
Type of Vehicles to be Sold
(Authorized Dealership Agent, Title)
Dealer License Number
I, the undersigned, certify under penalty of s.345.17 Wisconsin Statutes, that (1) a lease agreement covering at least the licensing year has been executed, if
premises are not owned by applicant, and (2) the answers and statements on this application are true and correct to the best of my
Area Code - Telephone Number
Trade Name(s) or DBAs
in last 12
List makes of new vehicles to be sold
Address of NONADJACENT Sales Location in SAME MUNICIPALITY
No, Attach completed service agreement
SELLER PERMIT NUMBER
Do you own and operate your own service department?
Was there a licensed dealer at this same location previously this year?
Yes, Name dealer ________________________________________
Have you, as an individual and your above-named firm, been licensed as a dealer before?
Yes, Same location?
Has your motor vehicle dealer license ever been denied, suspended or revoked?
Yes, When and what state? _________________________________
Are you licensed as a motor vehicle salvage dealer at same location?
Yes, Give license number __________________________________
State of Incorporation or Organization
If Corporation or LLC,
Date Licensed in Wisconsin
See reverse side.
Post Office Box Number
MOTOR VEHICLE DEALER
TWO YEAR LICENSE APPLICATION
Submit in duplicate.
CHECK PAYABLE TO: REGISTRATION FEE TRUST
Wisconsin Department of Transportation
Dealer and Agent Section
P.O. Box 7909
Madison, WI 53707-7909
MV2186 2/2008 Ch. 218 Wis. Stats.
Owner of sole